Community Practice Research Articles

Simulated GP clinic closure: effects on patient access in the Irish Mid-West.

Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access. GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic. The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index ≥4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31). Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.

Mapping epistemic pluralism: A network analysis of discursive practices in communities promoting refused knowledge about healthcare and wellbeing

This article presents an analysis of discourses performed in communities that share and disseminate knowledge refused by institutional science. The study focuses on an online community concerned with alkaline water, food, and lifestyle, aiming at understanding how promoters of refused knowledge in this community enrol other forms of knowledge, including science. Theoretically, this work is framed in Science & Technology Studies, and in the tradition of actor-network theory, situating itself in a recent turn that takes epistemic instability and pluralism into due consideration, thus overcoming opaque views of the opposition between science and non-science. Empirically, this fine-grained analytic purpose is addressed by a mixed-method strategy in which discursive practices are observed through a web-ethnography conducted between January 2020 and December 2021 on the relevant online spaces and then analysed qualitatively and quantitively by means of formal techniques. Relying on the tools of social network analysis, the discursive space of the community under study is formalised as a two-mode network of knowledge claims and heterogeneous actors enrolled in discourse to sustain those claims. Then, community detection is performed to map the different assemblages of claims and actors and the relevant repertoires characterising those assemblages. Finally, multiple correspondence analysis applied to two-mode networks is used to highlight the dimensions of concern and meaning expressed in the knowledge organisation of this community.

Native American and Indigenous Language Practices and Politics

The United Nations Educational, Scientific, and Cultural Organization (UNESCO) designated the years between 2022 and 2032 as the International Decade of Indigenous Languages in an attempt to promote language “preservation, revitalization and promotion.” Such statements convey more than advocacy; they also convey complex politics and histories surrounding settler-colonial and Indigenous encounters through, with, and for Indigenous languages and community practices. What will those encounters look and sound like at the end of the decade? This review traces trajectories toward possible outcomes and political configurations.

PHARM-LC: What role can Community Pharmacy play in supporting people with long Covid? Protocol for a mixed methods study

Background Long Covid is a debilitating multifaceted condition, that is more prevalent in those from deprived areas, females and those with another disorder or disability. Those that live with Long Covid currently must endure a lack of services, support and have also reported being ‘gaslit’ by health care professionals. Primary care services such as GP surgeries are under immense pressure and have limited resources to offer those that live with Long Covid. Community pharmacy could be a localised solution for those that need support and advice for Long Covid as they have already proven to be a reliable source during the COVID-19 pandemic. This study aims to address gaps in research to explore the possible role that community pharmacy teams can play in supporting those living with Long Covid. Protocol A two-phase multi-method study using semi-structured interviews and co-design will be utilised. For phase one: two population groups; those with lived experience of Long Covid and community pharmacy team members will be interviewed to understand their current experiences of community pharmacy supporting those living with Long covid, as well as lived experiences and self-management (people with Long Covid), and training needs, and current practice (Community pharmacy teams). For phase two: a co-design approach will be utilised with key stakeholders to help inform online training via multiple workshops. This training will be then piloted by end users, who will provide post training feedback via a survey. Discussion Understanding the role that community pharmacy can play in supporting those with Long Covid and to facilitate development of this new support pathway to develop online training which provides pharmacy teams with a structured and cohesive approach to care.

A multi-embankment Chalcolithic walled enclosure

Ota, a key part of the Chalcolithic walled enclosure phenomenon in Portuguese Estremadura, represents a unique settlement strategy within the actual territory of Portugal. The architecture and social dynamics of this site remained largely unexplored until 2019. This study marks a significant shift in its study, utilizing a synergistic approach of archaeology and geotechnologies, embodied in the using an Unmanned Aerial Vehicle equipped with LiDAR. This innovative combination successfully penetrated the dense vegetation, revealing 21 previously unknown archaeological features. The results from the fieldwork unveiled a novel type of walled enclosure at Ota, characterized by a series of four embankments. This discovery prompts a re-evaluation of the roles and practices of 3rd millennium BC communities in Portuguese Estremadura. Furthermore, the proven efficacy of this methodology paves the way for its application in similar archaeological contexts. The paper presents a comprehensive analysis of the recent fieldwork, integrating interpretations from LiDAR data, material studies and 14C dating.

Engaging Multidisciplinary Teams to Develop Pragmatic Clinical Practice Guidelines to Support Management of Patients With High-Risk Breast Lesions

IntroductionWe sought to develop clinical guidelines within our multidisciplinary Breast Center to support decision-making for managing high-risk breast lesions. The objective is to describe the process used to develop these guidelines and assess perceived acceptability. MethodsWe recruited clinical stakeholders to identify key “high-risk” topics. Stakeholder groups (surgery, radiology, pathology) met separately to review the topics, leveraging existing literature reviews and best available evidence. Guidelines were initially developed in 2015 and updated in 2019. We surveyed breast clinical team members in 2023 regarding the perceived acceptability of the guidelines and summarized the data. ResultsWe created clinical guidelines to address the management of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia/lobular carcinoma in situ, radial scar/complex sclerosing lesion, and papillomas. Key guideline components included process for radiologic-pathologic correlation, patient disposition after biopsy (surgical referral needed, follow-up imaging recommended), recommendation for the role of surgical excision, and recommendation regarding imaging follow-up if excision not performed. Forty clinical team members (66% [40/60] response rate) completed the acceptability survey from varied disciplines. Most (78%) were aware of the guidelines. Respondents rated the recommendations for disposition after biopsy, surgical management, and follow-up imaging as the most helpful components. Most (> 80%) rated them to be very/extremely useful. ConclusionWe leveraged input from key stakeholders to develop clinical guidelines to support the multidisciplinary management of patients with high-risk breast lesions. Our guidelines have been successfully implemented across our academic and community practice. Future steps will assess the impact of implementation on clinical outcomes.

Welcome to #SpoonieTok: Understanding and supporting disability expertise storytelling abilities and collective information practices on TikTok and beyond

This work-in-progress poster explores individual and collective storytelling and information creation practices in chronic illness TikTok communities, with the ultimate goal to support these embodied, creative, and multimodal abilities on and off-app through codesigned storytelling support materials. Findings from ongoing data collection and grounded theory coding, include folks’ sharing of disability expertise: using platform features to visualize invisible disability; audio, visual, and community-specific mimetic options. Interviews with 11 community members illuminate how disabled creators on TikTok engage in algorithmically-mediated online health communities, which have slippery boundaries where information can be found serendipitously through algorithmic ranking, and foster opportunities to develop storytelling skills.

MA18.11 The Evolution of the Lung Screening Network: Uniting to Strengthen Community and Share Best Practices Among Navigators

MA18.11 The Evolution of the Lung Screening Network: Uniting to Strengthen Community and Share Best Practices Among Navigators

Application of new genre public art in community empowerment: a case study of Chongqing Tie Lu San Cun Village, China

Abstract Purpose This paper aims to explore the necessity of using new genre public art (NGPA) to enhance community empowerment based on the characteristics of this art form and in conjunction with community empowerment theory. The study analyzes representative cases of NGPA to investigate its potential for strengthening community empowerment. Methodology The research primarily employs a case study approach, which selects samples based on their influence and project sustainability to examine the characteristics of NGPA. Content The study first analyzes the theories and characteristics of community empowerment and NGPA. Then, it selects the community practice activities of NGPA in Chongqing’s Tie Lu San Cun Village (Railway Third Village) as a case for empowerment analysis. Finally, it discusses the achievements of the project and the areas that need improvement. Conclusion and recommendations The findings show that NGPA can enhance community empowerment. They propose methods for improving areas that need enhancement and provide academic insights for policymakers to support artistic practices due to their benefits for community empowerment.

Implications of Traditional Cooking on Air Quality and Female Health: An In-Depth Analysis of Particulate Matter, Carbon Monoxide, and Carbon Dioxide Exposure in a Rural Community

Indoor air pollution, particularly in rural communities, is a significant health determinant, primarily due to the prevalence of traditional cooking practices. The WHO estimates 4.3 million annual deaths related to household air pollution. This study quantifies indoor pollutants and assesses health impacts and perceptions regarding traditional cooking. Using Extech air quality monitoring equipment, the study measured particulate matter (PM), carbon monoxide (CO), and carbon dioxide (CO2) in 48 rural homes. A survey of 39 women gathered insights on their use of wood for cooking and perceptions of air quality. This dual approach analyzed both environmental and social dimensions. Findings showed fine particulate matter (0.3, 0.5, 1.0, and 2.5 μm) exceeded safety limits by threefold, while coarser particulates (5.0 and 10 µm) were concerning but less immediate. CO levels were mostly acceptable, but high concentrations posed risks. CO2 levels indicated good ventilation. Survey responses highlighted reliance on wood and poor air quality perceptions demonstrating little awareness of health risks. Common symptoms included eye discomfort, respiratory issues, and headaches. The study emphasizes the need for interventions to reduce exposure to indoor pollutants and increase awareness of health risks to encourage cleaner cooking practices in rural communities.

Empowering Communities through Citizen Science: Dengue Prevention in Córdoba.

Traditional mosquito vector control methods have proved ineffective in controlling the spread of dengue fever. This study aimed to assess the effectiveness of community engagement through student-led science in promoting dengue prevention and socioecological factors in the temperate urban city of Córdoba, Argentina. It assesses community perceptions, knowledge, attitudes, and preventive practices regarding dengue fever and its vector. Results showed a significant increase in knowledge about the vector and the disease and respondents' adoption of good preventive practices. Student-led science was identified as a valuable tool for reaching households and leading to behavior changes at home. Furthermore, the findings highlighted the need for school programs to address vector biology and vector-borne disease prevention all year round. This study provides invaluable insights into the effectiveness of community engagement through student-led science to promote dengue prevention and socioecological factors. The findings suggest that this approach could be used to control the spread in other regions affected by the disease.

Understanding the Current State of Community Health Nursing Education in Canada: An Exploration of the Erosion and Devaluation of Community Health Theoretical and Practice Education in Canadian Nursing Programs

Understanding the Current State of Community Health Nursing Education in Canada: An Exploration of the Erosion and Devaluation of Community Health Theoretical and Practice Education in Canadian Nursing Programs

General public knowledge, attitudes, and practices about rabies and associated factors in Gomma district of Jimma zone, southwestern Ethiopia.

Rabies is a disease of warm-blooded animals that affects the central nervous system and is almost invariably fatal once clinical signs develop. It is one of the most neglected tropical diseases in several areas of the world, including Ethiopia. Additionally, the burden of the disease is estimated to be high in Ethiopia, and public awareness contributes to prevention. A community-based cross-sectional study design was conducted from June-August 2023 in the Gomma district, Jimma zone, Oromia regional state, Ethiopia, to assess the knowledge, attitudes, and practices of communities towards rabies and associated risk factors using a structured questionnaire survey. A multi-stage sampling technique was used for the selection of the sampling units and a total of 140 participants were interviewed. The questionnaire parts included socio-demographics information, knowledge, attitudes, and practices of the community's respect for rabies management and control. The data was analyzed by Statistical Package for Social Science (SPSS) Version 20. Descriptive analyses were employed and multivariable logistic regression was used to calculate the association between independent and dependent variables (Knowledge, Attitudes, and Practice scores). About 134 (95.7%) respondents had heard about rabies. Likewise, 75 (53.6%), 55 (39.3%), and 95 (67.9%) of the respondents had good knowledge, favorable attitudes, and good practices, respectively. Christians were more likely to have higher knowledge scores than Muslims (AOR = 6.876, CI = 1.750-27.016, p = 0.006). Respondents who knew someone's exposure had a higher knowledge score than those who did not (AOR = 6.208, CI = 2.750-14.012, p = 0.000). Moreover, Muslims were found to have a more favorable attitudes than Christians (AOR = 5.518, CI = 1.199-25.391, p = 0.028). Those who knew someone's exposure to rabies were found to have a more favorable attitudes than those who did not (AOR = 2.367, CI = 1.157-4.839, p = 0.018). Respondents who had favorable attitudes towards rabies were found to have more good practices than unfavorable attitudes (AOR = 3.267, CI = 1.391, 7.730, p = 0.005). The study revealed a gap in knowledge among communities in the study area. Thus, rabies control activity and community awareness should be implemented with stakeholders.

A look at the treatment of the contents of Agroecology as a component of agricultural education in Biology 1

<p>Currently, the study of Agroecology as a component of agricultural education in the subject of Biology 1 and the treatment of its contents at the basic secondary educational level is of great importance. Agricultural education is of vital importance to achieve sustainable development, adopting environmental, economic and social policies based on agroecological principles related to food production and local development from the Cuban educational system. In this sense, it is necessary for teachers to promote and encourage students towards the use of agroecological practices to contribute to the education of current and future generations in love and respect for rurality and for the school to become an extensionist of the agrarian culture. The objective of this article is: to systematize the theoretical foundations of Agroecology as a component of agricultural education and the treatment of its contents, promoting agroecological practices on the basis of food sovereignty and security. To achieve this objective, theoretical (analytical-synthetic; inductive-deductive) and empirical (observation; documentary analysis and interview) methods were used. The importance of this work lies in seventh grade students being able to develop agroecological practices in school, family and community with a view to finding possible solutions to the problems associated with production processes to support family food security.<strong></strong></p>

Language practices of Emilian and Esperanto communities: spaces of use, explicit language attitudes and self-reported competence

ABSTRACT This paper provides a comparative analysis of the language practices maintained by speakers of two minoritised languages: Emilian and Esperanto. Esperanto is seemingly maintaining itself more successfully than Emilian and can therefore serve as an insightful point of comparison. The aim of this study is to quantify spaces of language use and attitudes towards each language to investigate the following: (i) spaces of language use and (ii) explicit language attitudes in the two communities, and (iii) the relationship between spaces, language attitudes and self-reported competence. We administered an online sociolinguistic questionnaire over the summer of 2020, collecting 468 responses for Emilian and 154 for Esperanto. Results from Bayesian linear models suggest that the relationship between language attitudes and competence is modulated by spaces of use: at lower proportions of spaces of use, language attitudes are more positively correlated with language competence, while at higher proportions of spaces of use, the relationship between attitude and competence is reduced. Although Emilian is maintained in fewer spaces than Esperanto, we observe that it is still used in local spaces. We propose that creating spaces for users of minoritised languages like Emilian could engender higher levels of language competence and hence language maintenance.

Ethics and Practice in Communities of Care

The Society for Social Studies of Science (4S) annually awards the John Desmond Bernal Prize to one or more individuals who have made distinguished contributions to the field of Science and Technology Studies. Past winners have included founders of the field, along with outstanding scholars who have devoted their careers to the understanding of the social dimensions of science and technology. This article is the revised text of Joan H. Fujimura's 2023 Bernal Lecture.

The Role of Community Beliefs and Practices on the Spread of Ebola in Uganda, September 2022.

On September 20, 2022, Uganda declared an Sudan Virus Disease (SVD) outbreak in Mubende District. Another eight districts were infected September-November 2022. We examined how Ugandan community beliefs and practices spread Sudan Ebola Virus (SUDV) in 2022. A qualitative study was conducted in Mubende, Kassanda, and Kyegegwa districts in February 2023. Nine focus group discussions and six key informant interviews were held. We investigated whether community beliefs and practices contributed to spreading Sudan Ebola Virus (SUDV). Interviews were recorded, translated, transcribed, and thematically analyzed. The community deaths, later found to be due to Sudan Virus Disease(SVD), were often attributed to witchcraft or poisoning. Key informants reported that SVD patients often sought traditional healers or spiritual leaders before or after formal healthcare failed. They also found that traditional healers treated SVD patients without precautions. Religious leaders praying for SVD patients and their symptomatic contacts, SVD patients hiding in friends' homes, and exhuming SVD patients from safe and dignified burials to allow traditional burials were other themes. Diversity in community beliefs and culture likely contributed to spreading the 2022 Ugandan SVD outbreak. Public health systems, traditional healers, and religious leaders can help Uganda control ebolavirus outbreaks by identifying socially acceptable and scientifically supported infection control methods.

On the creation of state-owned companies in the field of food retail: the experience of Russia and foreign countries

With regard to the discussions circulating among practitioners, retailers and the scientific community on the idea of launching a new state-owned retail chain in Russia, the article analyzes approaches to the legal framework of state-owned retail chains in Brazil, North Korea and China, which adhere to diametrically opposite arguments regarding their activities, which, of course, is useful for the Russian scientific and practical community to know. The author comes to the conclusion that the idea of state-owned retail chains is discredited as having tendencies towards bureaucratization, corruption, the formation of an incorrect distribution of national wealth, poor organization of their activities, rooted not in the phenomenon itself, but in the minds of the people who lead them into life, many of whom are greedy and always look for and often find loopholes in the laws. Thus, further development of existing digital mechanisms in the form of assessment systems based on econometric approaches as Computable General Equilibrium (CGE) will solve this problem.

Transitioning to rural practice together: a rural fellowship model (in 6 Ps).

Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice. To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework. An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills. The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

Recruitment and retention of new doctors in remote and Aboriginal medical services through the Remote Vocational Training Scheme's Targeted Recruitment Strategy: a focus group study.

To explore the results of a targeted recruitment strategy designed to attract and retain new doctors in remote and Aboriginal medical services where they can access Remote Vocational Training Scheme (RVTS) training and support to qualify as general practitioners. Two 2-hour purposeful online focus groups on the RVTS' Targeted Recruitment Strategy. Five participants and nine stakeholders with knowledge and experience of the strategy. Data were transcribed and deductively and inductively coded for themes including insights from separate project reference and stakeholder advisory groups. Perspectives of the strategy. The overarching theme was that the strategy is useful for attracting and retaining new general practitioners in areas of high need and is potentially scalable. Since 2018, 20 new doctors were recruited via the Targeted Recruitment Strategy and six of them completed the RVTS program. The strategy could better differentiate target locations because increasing communities are experiencing major general practice workforce shortages. The package of employment and training could also be more clearly defined for participants, nationally marketed and collaboratively implemented. Further, more site accreditation and ongoing risk and quality review is needed, along with intense early supports for participants who are new to both the community and general practice work. The Targeted Recruitment Strategy is still maturing but the early results suggest it is a unique and proactive model for attracting and improving access to general practitioners in places with high needs. It could be strengthened through formal agreements between communities and agencies, ensuring coordinated implementation, clarifying roles and responsibilities, and developing clear pathways for risk and quality management.